Ischio-femoral impingement: the hip pain mimic

Continuing with our series on uncommon injuries, Chris Mallac discusses ischio-femoral impingement (IFI) in today’s feature article. Mimicking other syndromes, the symptoms of IFI include pain in the buttocks or posterior hip that worsens after prolonged sitting and may radiate to the back of the leg. Spanish researchers recently reported a case of a 36-year-old female Olympic athlete who developed IFI after receiving a hamstring tendon reattachment(1). Although a rare diagnosis, their review of the literature led them to believe that IFI is under detected and possibly occurs more often that realized. This possibly occurs because IFI mimics the symptoms of nearly every other hip injury.

Why is it important to know about ‘rare birds’ such as IFI? Because as Italian researchers point out in a just released review of hip lesions in soccer players, misdiagnosis prolongs healing and return to play(2). In the worst case scenario, misdiagnosis allows further damage to take place, putting an athlete’s competition season or entire career in jeopardy. As it turns out, IFI is more frequent in specific populations, such as soccer players, ballet dancers, and rowers because these athletes spend time in the position of impingement: external rotation, extension, and adduction (see figures 1 and 2).

Figure 1: Anatomy of hip showing the proximity of the lesser trochanter with the ischial tuberosity. When this space is narrow congenitally, after injury, or surgery, impingement of intervening tissues is possible.

Figure 2: Soccer kick wind up in hip extension, external rotation, and adduction.

During this month, we will continue to explore ‘uncommon’ issues with athletes, such as working with the parathlete and the pregnant athlete. While not the bread and butter of any facility’s schedule, these athletes too deserve a knowledgeable professional to help them with injuries and challenges. It’s our mission, here at, to bring science to treatment, and we would be remiss if we didn’t inform you about the obscure as well as the commonplace. Have you been surprised by an unusual diagnoses? Message us on Facebook or Twitter and maybe we’ll feature your ‘uncommon’ injury in a future article!


  1. Rev Esp Cir Ortop Traumatol.2018 Mar 31.[Epub ahead of print]
  2. Eur J Radiol.2018 Aug;105:227-238


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